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25.06.2020 | Original Article

The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates

verfasst von: Giuseppe Magistro, Patrick Keller, Thilo Westhofen, Melanie Schott, Alexander Tamalunas, Philipp Weinhold, Christian G. Stief

Erschienen in: World Journal of Urology | Ausgabe 5/2021

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Abstract

Purpose

To evaluate the diagnostic value of a high preoperative PSA level for the detection of incidental prostate cancer (iPCa) in LUTS patients with very large prostates (> 100 cc).

Methods

We conducted a retrospective analysis of 1125 men treated for LUTS with holmium laser enucleation of the prostate (HoLEP). Patients were stratified according to a preoperative PSA level higher (high PSA; n = 365) or lower than 10 ng/ml (low PSA; n = 760). Preoperative and histopathological parameters were compared between both cohorts. Logistic regression models were used to identify independent predictors of iPCa.

Results

Demographic parameters were similar between both cohorts. The median PSA levels were 14.2 ng/ml (11.5–19.9) and 4 ng/ml (2.4–6.0). The prostate volume was significantly higher in the high PSA group (105 cc vs. 75 cc; p < 0.001). Correspondingly, the PSA density was significantly increased in the high PSA cohort compared to the low PSA cohort (0.14 vs. 0.05; p < 0.001). The overall detection rate of iPCa showed no difference between groups (9.5% vs. 9.9%). More preoperative prostate biopsies were performed in the high PSA group compared to the low PSA group (46.8% vs. 17.6%; p < 0.001). However, the rate of false negative results was comparable between groups (12.7% vs. 11.1%; p = 0.726). In logistic regression models all PSA-related parameters failed to predict iPCa.

Conclusions

PSA-guided approaches to predict iPCa in LUTS patients with very large prostates are not accurate. This finding is useful in clinical practice for counselling our patients and to prevent unwarranted diagnostic procedures.

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Titel: The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates
verfasst von: Giuseppe Magistro
Patrick Keller
Thilo Westhofen
Melanie Schott
Alexander Tamalunas
Philipp Weinhold
Christian G. Stief
Publikationsdatum: 25.06.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 5/2021
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03321-w

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The significance of a high preoperative PSA level for the detection of incidental prostate cancer in LUTS patients with large prostates